Factors influencing outcomes in neonatal abdominal surgery: surgeons’ perspectives

Nimmita  Srisan; Kanyarat  Olarachin; Pattamon  Sutthatarn; Katawaetee  Decharun; Prapapan  Rajatapiti; Somboon  Reukvibunsi; Paisarn  Vejchapipat

Authors

Nimmita Srisan Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Kanyarat Olarachin Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Pattamon Sutthatarn Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Katawaetee Decharun Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Prapapan Rajatapiti Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Somboon Reukvibunsi Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Paisarn Vejchapipat Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Keywords:

Neonatal abdominal surgery, neonatal mortality, risk factors, surgical complications

Abstract

Background: Neonatal abdominal surgery is often indicated by congenital conditions, which present considerable morbidity and mortality risks. However, comprehensive surgical data and identification of complication-related risk factors are still lacking.

Objective: The objectives of this study were to characterize neonatal patients undergoing abdominal surgery and to identify prognostic factors associated with complications and mortality.

Methods: A retrospective study was conducted on newborn patients aged 0–30 days who underwent index surgery at a university hospital from 2013 to 2021. Categorical data were compared between the with and without complications groups. Complications were defined as any events that required intervention, either surgical or medical.

Results: There were 154 neonates undergoing 173 index procedures, and 19 patients had more than one condition. The five most common conditions requiring abdominal surgery included abdominal wall defect (31.0%), colorectal disease (16.0%), intestinal atresia (14.0%), necrotizing enterocolitis (8.0%), and meconium peritonitis (7.0%). The incidence of patients with at least one complication was 44.8%, and the mortality rate was 7.8%. Using logistic regression, factors associated with complications included birth weight <1,000 g (P = 0.01), APGAR (CDH) (P = 0.04), and operative time >110 min (P = 0.03). Significant influences on mortality were birth weight <1000 g (P = 0.02), cardiovascular anomalies (P = 0.02), CDH (P = 0.001), and platelet count <100,000/µL (P = 0.03).

Conclusion: This study provides valuable insights into factors that influence outcomes in neonatal abdominal surgery. Birth weight <1000 g, CDH, and operative time >110 min were identified as significant contributors to complications. Furthermore, birth weight < 1000 g, cardiovascular anomalies, CDH, and platelet count <100,000/µL strongly influence mortality. These findings emphasize the complexity of neonatal abdominal surgery with various conditions. Understanding these prognostic factors can help predict the outcome of neonatal abdominal surgery, and improving these outcomes may be achievable in the future.

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